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Non-communicable disease clinics in rural Ethiopia: why patients are lost to follow-up

Non-communicable disease clinics in rural Ethiopia: why patients are lost to follow-up
Non-communicable disease clinics in rural Ethiopia: why patients are lost to follow-up
Objective: Providing effective medical care for non-communicable diseases (NCD) in rural sub-Saharan Africa has proved to be difficult because of poor treatment adherence and frequent loss to follow-up (LTFU). As the reasons are poorly understood, we have investigated LTFU in a rural Ethiopian community among patients with two contrasting, but common NCDs.

Method: The study was based in five health centres in southern Ethiopia providing services for surrounding rural populations where NCD clinics run by nurses and health officers were initiated in 1998. Samples of LTFU patients with epilepsy and hypertension were identified and traced through health extension workers. A questionnaire enquiring about the reasons for LTFU was administered to LTFU patients and non-LTFU, comparison patients.

Results: Of 268 LTFU patients, the current status of 147(54.9%) was ascertained. Of these 62 had died, moved away or were continuing medical care at other facilities. The remaining patients (48 with epilepsy and 37 with hypertension) were compared with 113 non-LFTU patients with epilepsy and 98 with hypertension attending the same clinics. The major factors associated with LTFU were distance from the clinic, associated costs and a preference for traditional treatments together with misunderstanding as to the nature of NCD management.

Conclusions: We conclude that the delivery of low cost, affordable care closer to the patients’ homes has the greatest potential to address the problem of LTFU. Also needed are increased levels of patient education and interaction with traditional healers to explain the nature of NCDs and the need for life-long management.
Hypertension, epilepsy, NCD clinics, rural health, default, Ethiopia
2220-8372
Levene, Dan
fdf6fd40-020a-4cbb-b953-d5c2dcc6a002
Phillips, David
29b73be7-2ff9-4fff-ae42-d59842df4cc6
Mamo, Yoseph
54890fc0-664b-4ad0-b820-660c18854390
Mortimore, Andrew
6d0c7524-175a-4396-b1a4-f6cd1aabee00
Dee, Dominic
73e92c6c-7273-474c-9aae-05c2cb1f2a93
Akish, Luintel
20ee2041-6c55-4323-84cd-68a8c20f64cf
Imogen, fordham
3d35e38d-8bfc-4f0f-8ac7-9ce76f7770de
Eldryd, Parry
9ed30135-d451-47b8-b763-0e2234e39827
Levene, Dan
fdf6fd40-020a-4cbb-b953-d5c2dcc6a002
Phillips, David
29b73be7-2ff9-4fff-ae42-d59842df4cc6
Mamo, Yoseph
54890fc0-664b-4ad0-b820-660c18854390
Mortimore, Andrew
6d0c7524-175a-4396-b1a4-f6cd1aabee00
Dee, Dominic
73e92c6c-7273-474c-9aae-05c2cb1f2a93
Akish, Luintel
20ee2041-6c55-4323-84cd-68a8c20f64cf
Imogen, fordham
3d35e38d-8bfc-4f0f-8ac7-9ce76f7770de
Eldryd, Parry
9ed30135-d451-47b8-b763-0e2234e39827

Levene, Dan, Phillips, David, Mamo, Yoseph, Mortimore, Andrew, Dee, Dominic, Akish, Luintel, Imogen, fordham and Eldryd, Parry (2019) Non-communicable disease clinics in rural Ethiopia: why patients are lost to follow-up. Public Health Action. (In Press)

Record type: Article

Abstract

Objective: Providing effective medical care for non-communicable diseases (NCD) in rural sub-Saharan Africa has proved to be difficult because of poor treatment adherence and frequent loss to follow-up (LTFU). As the reasons are poorly understood, we have investigated LTFU in a rural Ethiopian community among patients with two contrasting, but common NCDs.

Method: The study was based in five health centres in southern Ethiopia providing services for surrounding rural populations where NCD clinics run by nurses and health officers were initiated in 1998. Samples of LTFU patients with epilepsy and hypertension were identified and traced through health extension workers. A questionnaire enquiring about the reasons for LTFU was administered to LTFU patients and non-LTFU, comparison patients.

Results: Of 268 LTFU patients, the current status of 147(54.9%) was ascertained. Of these 62 had died, moved away or were continuing medical care at other facilities. The remaining patients (48 with epilepsy and 37 with hypertension) were compared with 113 non-LFTU patients with epilepsy and 98 with hypertension attending the same clinics. The major factors associated with LTFU were distance from the clinic, associated costs and a preference for traditional treatments together with misunderstanding as to the nature of NCD management.

Conclusions: We conclude that the delivery of low cost, affordable care closer to the patients’ homes has the greatest potential to address the problem of LTFU. Also needed are increased levels of patient education and interaction with traditional healers to explain the nature of NCDs and the need for life-long management.

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More information

Accepted/In Press date: 23 May 2019
Keywords: Hypertension, epilepsy, NCD clinics, rural health, default, Ethiopia

Identifiers

Local EPrints ID: 431236
URI: https://eprints.soton.ac.uk/id/eprint/431236
ISSN: 2220-8372
PURE UUID: 11f0bd17-c40d-459d-994a-5f57bac69fcd

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Date deposited: 28 May 2019 16:30
Last modified: 28 Aug 2019 16:32

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Contributors

Author: Dan Levene
Author: David Phillips
Author: Yoseph Mamo
Author: Andrew Mortimore
Author: Dominic Dee
Author: Luintel Akish
Author: fordham Imogen
Author: Parry Eldryd

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